Association Between Dietary Patterns, Work Stress, Physical Activity, and Cardiometabolic Markers Among University Workers in Ghana: A Cross-Sectional Study.

Parkinson’s disease (PD) is a neurodegenerative disorder clinically characterized by bradykinesia, coarse resting tremor, characteristic gaits, and nonmotor symptoms such as autonomic instability, depression, and sleep disturbances [], while sensory disturbances such as pain and paresthesia have also been described []. Treatment commonly involves dopaminergic drugs aimed to restore and preserve ambulatory functions. Levodopa, a dopamine precursor used in combination with either carbidopa or benserazide, is one of the most commonly prescribed first-line agents [–]. Despite clear clinical benefits, levodopa has been associated with adverse effects such as gastrointestinal disturbances, postural hypotension, and neuropsychiatric symptoms such as impulsivity, psychosis, and confusion. Relevant to somatosensory adverse effects, levodopa has been associated with chronic sensory neuropathy, partly attributed to hyperhomocysteinemia and methylmalonic acid accumulation [–], although neuropathy can also emerge as a feature of PD, independent of levodopa exposure [–]. Nevertheless, acute somatosensory disturbances, particularly thermal sensations, in relation to levodopa administrations have been rarely reported. Here, we describe a patient with PD who repeatedly developed acute generalized heat sensations following administration of different levodopa formulations, with the symptoms initially misconstrued as somatization. This case report describes a 69-year-old woman with PD, without other medical comorbidities, who repeatedly developed generalized heat sensations after exposure to levodopa. The case report was approved by the Human Research Ethics Committee of Srinakharinwirot University (SWUEC-693016). The patient was treated in accordance with the Declaration of Helsinki. The patient’s PD was diagnosed 8 years earlier at a different hospital. Per history, the initial clinical presentation that led to evaluation and PD diagnosis was rigidity, subjectively perceived by the patient as limb heaviness and difficulty inhaling fully. Tremor was absent, reportedly contributing to initial delays in seeking evaluation for PD. Subsequent positron emission tomography imaging demonstrated dopaminergic abnormalities consistent with PD, including bilateral parietotemporal hypometabolism and increased fluorodeoxyglucose uptake in the bilateral caudate and putamen. Pharmacological treatment was reportedly initiated, though specific medication and dose information are unavailable; the patient denied medication-related adverse effects at that time.